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Hamishegi FS, Singh R, Baruah D, Chamberlin J, Hamouda M, Akkaya S, Kabakus I. Drug-induced Acute Lung Injury: A Comprehensive Radiologic Review. J Thorac Imaging 2024:00005382-990000000-00159. [PMID: 39330765 DOI: 10.1097/rti.0000000000000816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Drug-induced acute lung injury is a significant yet often underrecognized clinical challenge, associated with a wide range of therapeutic agents, including chemotherapy drugs, antibiotics, anti-inflammatory drugs, and immunotherapies. This comprehensive review examines the pathophysiology, clinical manifestations, and radiologic findings of drug-induced acute lung injury across different drug categories. Common imaging findings are highlighted to aid radiologists and clinicians in early recognition and diagnosis. The review emphasizes the importance of immediate cessation of the offending drug and supportive care, which may include corticosteroids. Understanding these patterns is crucial for prompt diagnosis and management, potentially improving patient outcomes.
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Affiliation(s)
| | - Ria Singh
- Osteopathic Medical School, Kansas City University, Kansas, MO
| | - Dhiraj Baruah
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Jordan Chamberlin
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Mohamed Hamouda
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Selcuk Akkaya
- Department of Radiology and Radiological Science, Karadeniz Technical University, Trabzon, Turkey
| | - Ismail Kabakus
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
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2
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Prater A, Hinson-Enslin A, McClintock H, Anderson J. Vision Loss and Substance Misuse: A Systematic Review. Subst Use Misuse 2024; 59:2084-2093. [PMID: 39175153 DOI: 10.1080/10826084.2024.2392561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Background: The number of people in the U.S. affected by sensory disabilities and/or substance use has continued to increase, but the relationship between them has yet to be fully understood. The purpose of this review is to assess the relationship between substance use and vision loss in the U.S. as described by current literature. Methods: A search of published literature was conducted across MEDLINE, APA PsycINFO, Web of Science, and EBSCO: Psychology and Behavioral Sciences Collection, and CINAHL following the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) protocol. Risk of bias was assessed by the authors based on study design. U.S. based studies written in English between 2010 and 2022 that reported on vision loss and substance use were included. Results: In all, 21 articles were included (case reports 11, case series 1, cross-sectional 4, retrospective cohort 3, review 2) representing 89,132 patients. Nineteen studies found a positive association between vision loss and substance use, with 15 studies suggesting substance use was a risk factor for vision loss. One study reported on vision loss preceding substance use but was inconclusive. Conclusions: Our findings suggest that substance use may be a risk factor for vision loss, and we recommend that providers screen for vision loss in at risk patients to mitigate further disability. Further research is needed to assess the impact visual disabilities may have on substance use, and stronger evidence is needed to verify if substance use is truly a risk factor for vision loss.
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Affiliation(s)
- Amber Prater
- Department of Population and Public Health Sciences, Wright State Boonshoft School of Medicine, Fairborn, Ohio, USA
| | - Amanda Hinson-Enslin
- Department of Population and Public Health Sciences, Wright State Boonshoft School of Medicine, Fairborn, Ohio, USA
| | - Heather McClintock
- Department of Public Health, Arcadia University, Glenside, Pennsylvania, USA
| | - Joanna Anderson
- Department of Population and Public Health Sciences, Wright State Boonshoft School of Medicine, Fairborn, Ohio, USA
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Charkhat Gorgich EA, Rigi MG, Fanaei H, Parsaei H, Ghanbarzehi A. Brain-derived neurotrophic factor serum levels as a candidate biomarker for withdrawal in crack heroin dependence. Subst Abuse Treat Prev Policy 2024; 19:9. [PMID: 38245698 PMCID: PMC10800061 DOI: 10.1186/s13011-024-00591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Crack heroin is a novel opiate derivative with highly addictive properties and unfamiliar health consequences. It causes a variety of brain dysfunctions that are mediated by neurochemical alterations and abnormal neuroplasticity. Brain-derived neurotrophic factor (BDNF) is a widely recognized biological marker implicated in the neuropathology of substance use during substance use disorder and withdrawal. Its involvement can significantly contribute to the severity of withdrawal symptoms. Hence, this study aimed to evaluate BDNF levels in crack heroin users before and after withdrawal. METHODS In this cross-sectional study, 148 male participants were recruited and divided into two groups: persons with crack heroin use disorder (n = 74) and the controls (n = 74). The BDNF serum levels were measured in both crack heroin users and control groups upon hospitalization and again after twenty-one days of withdrawal using the enzyme-linked immunosorbent assay. RESULTS The results demonstrated that BDNF levels in persons with crack heroin use disorder upon admission were significantly lower than the levels observed upon discharge and in the control group (p < 0.05). Additionally, a significant difference in BDNF levels was found between persons with crack heroin use disorder at admission and discharge (p = 0.038). Furthermore, BDNF levels showed an inverse correlation with the daily dose of substance use (r= -0.420, p = 0.03) and the duration of crack heroin use (r= -0.235, p = 0.001). CONCLUSIONS A progressive increment in BDNF levels during early detoxification is associated with the daily amount of substance use and the duration of substance use. Our findings suggest that changes in BDNF serum levels during crack heroin use disorder and withdrawal could serve as potential biomarkers for assessing the intensity of withdrawal symptoms and substance use-related behaviors.
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Affiliation(s)
| | | | - Hamed Fanaei
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Houman Parsaei
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Anatomy, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Abdolhakim Ghanbarzehi
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
- Department of Neuroscience, School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Department of Physiology, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran.
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Hofmarcher T, Leppänen A, Månsdotter A, Strandberg J, Håkansson A. Societal costs of illegal drug use in Sweden. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104259. [PMID: 38035447 DOI: 10.1016/j.drugpo.2023.104259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Illegal drug use is a public health concern with far-reaching consequences for people who use them and for society. In Sweden, the reported use of illegal drugs has been growing and the number of drug-induced deaths is among the highest in Europe. The aim of this study was to provide a comprehensive and up-to-date estimation of the societal costs of illegal drug use in Sweden, relying as much as possible on registry and administrative data. METHODS A prevalence-based cost-of-illness study of illegal drug use in Sweden in 2020 was conducted. A societal approach was chosen and included direct costs (such as costs of health care, social services, and the criminal justice system), indirect costs (such as lost productivity due to unemployment and drug-induced death), and intangible costs (such as reduced quality of life among people who use drugs and their family members). Costs were estimated by combining registry, administrative, and survey data with unit cost data. RESULTS The estimated societal costs of illegal drug use were 3.7 billion euros in 2020. This corresponded to 355 euros per capita and 0.78 % of the gross domestic product. The direct and intangible costs were of similar sizes, each contributing to approximately 40 % of total costs, whereas indirect costs contributed to approximately 20 %. The largest individual cost components were reduced quality of life among people who use drugs and costs of the criminal justice system. CONCLUSION Illegal drug use has a negative impact on the societal aim to create good and equitable health in Sweden. The findings call for evidence-based prevention of drug use and treatment for those addicted. It is important to address the co-morbidity of mental ill-health and drug dependence, to develop low-threshold services and measures for early prevention among children and young adults, as well as to evaluate laws and regulations connected to illegal drug use.
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Affiliation(s)
- Thomas Hofmarcher
- IHE - The Swedish Institute for Health Economics, Råbygatan 2, 22361 Lund, Sweden
| | - Anne Leppänen
- Public Health Agency of Sweden, Box 505, 83126 Östersund, Sweden
| | - Anna Månsdotter
- Public Health Agency of Sweden, Box 505, 83126 Östersund, Sweden; Department of Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden
| | | | - Anders Håkansson
- Clinical Addiction Research Unit, Lund University, Universitetssjukhuset, 22184 Lund, Sweden.
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Gallagher JP, Twohig PA, Crnic A, Rochling FA. Illicit Drugs and Candidates for Endoscopy and Surgery. RECENT STRATEGIES IN HIGH RISK SURGERY 2024:127-144. [DOI: 10.1007/978-3-031-56270-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Guedes Pinto T, Viana MDB, Cury PR, Martins MD, dos Santos JN, Ribeiro DA. Are Cytomorphogenetic Events Correlated with Oral Mucosal Lesions Induced by Crack Cocaine Use? A Systematic Review. PATHOPHYSIOLOGY 2023; 30:630-639. [PMID: 38133146 PMCID: PMC10748150 DOI: 10.3390/pathophysiology30040045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of this systematic review was to answer the question of whether crack cocaine can induce cellular and molecular alterations and whether such alterations are somehow related to clinical lesions in the oral mucosa. The searches were undertaken in three electronic databases and conducted based on the PRISMA 2020 statement. Eleven studies published between 1994 and 2020 were analyzed. The quality of the included studies was assessed by two independent reviewers (TGP and DAR) through a confounder's categorization methodology, in which final ratings were attributed (strong, moderate or weak) for each study. From 11 studies included, 7 evaluated the cellular/molecular impact of the addiction in a total of 492 individuals and compared to a control (non-exposure) group (n = 472). The main tests used for cellular alteration were MN and AgNORs. Cells from crack cocaine groups exhibited increased proliferation and MN counting. Only four studies evaluated the prevalence of oral lesions. All of them showed that individuals exposed to crack cocaine presented an increased number of oral lesions. Most studies showed good quality. In conclusion, our results demonstrate that crack use may induce changes at the cellular and molecular level and also exhibit an increased number of oral lesions. However, a correlation between such changes and oral mucosa lesions still needs further investigation and elucidation through other clinical studies in humans.
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Affiliation(s)
- Thiago Guedes Pinto
- Department of Biosciences, Institute of Health and Society, Federal University of São Paulo, Santos 11050-020, SP, Brazil; (T.G.P.); (M.d.B.V.)
| | - Milena de Barros Viana
- Department of Biosciences, Institute of Health and Society, Federal University of São Paulo, Santos 11050-020, SP, Brazil; (T.G.P.); (M.d.B.V.)
| | - Patricia Ramos Cury
- Department of Dental Clinics, School of Dentistry, Federal University of Bahia, Salvador 40170-110, BA, Brazil; (P.R.C.); (J.N.d.S.)
| | - Manoela Domingues Martins
- Department of Pathology and Stomatology, School of Dentistry, Federal Universty of Rio Grande do Sul, Porto Alegre 90010-150, RS, Brazil;
| | - Jean Nunes dos Santos
- Department of Dental Clinics, School of Dentistry, Federal University of Bahia, Salvador 40170-110, BA, Brazil; (P.R.C.); (J.N.d.S.)
| | - Daniel Araki Ribeiro
- Department of Biosciences, Institute of Health and Society, Federal University of São Paulo, Santos 11050-020, SP, Brazil; (T.G.P.); (M.d.B.V.)
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Robison CL, Cova N, Madore V, Allen T, Barrett S, Charntikov S. Assessment of ethanol and nicotine interactions using a reinforcer demand modeling with grouped and individual levels of analyses in a long-access self-administration model using male rats. Front Behav Neurosci 2023; 17:1291128. [PMID: 38098500 PMCID: PMC10720750 DOI: 10.3389/fnbeh.2023.1291128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023] Open
Abstract
Previous reports have indicated the reciprocal effects of nicotine and ethanol on their rewarding and reinforcing properties, but studies using methodological approaches resembling substance use in vulnerable populations are lacking. In our study, rats first self-administered ethanol, and their sensitivity to ethanol's reinforcing effects was assessed using a reinforcer demand modeling approach. Subsequently, rats were equipped with intravenous catheters to self-administer nicotine, and their sensitivity to nicotine's reinforcing effects was evaluated using the same approach. In the final phase, rats were allowed to self-administer ethanol and nicotine concurrently, investigating the influence of one substance on the rate of responding for the other substance. Group analyses revealed notable differences in demand among sucrose, sweetened ethanol, and ethanol-alone, with sucrose demonstrating the highest demand and ethanol-alone exhibiting greater sensitivity to changes in cost. At the individual level, our study finds significant correlations between rats' demand for sucrose and sweetened ethanol, suggesting parallel efforts for both substances. Our individual data also suggest interconnections in the elasticity of demand for sweetened ethanol and ethanol-alone, as well as a potential relationship in price response patterns between ethanol and nicotine. Furthermore, concurrent self-administration of ethanol and nicotine at the group level displayed reciprocal effects, with reduced responding for nicotine in the presence of ethanol and increased responding for ethanol in the presence of nicotine. This study provides valuable insights into modeling the co-use of ethanol and nicotine and assessing their interaction effects using reinforcer demand modeling and concurrent self-administration or noncontingent administration tests. These findings contribute to our understanding of the complex interplay between ethanol and nicotine and have implications for elucidating the underlying mechanisms involved in polydrug use.
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Affiliation(s)
| | - Nicole Cova
- Department of Psychology, University of New Hampshire, Durham, NH, United States
| | - Victoria Madore
- Department of Psychology, University of New Hampshire, Durham, NH, United States
| | - Tyler Allen
- Department of Psychology, University of New Hampshire, Durham, NH, United States
| | - Scott Barrett
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Sergios Charntikov
- Department of Psychology, University of New Hampshire, Durham, NH, United States
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Anzar N, Suleman S, Singh Y, Parvez S, Khanuja M, Pilloton R, Narang J. Wearable Electrochemical Glove-Based Analytical Device (eGAD) for the Detection of Methamphetamine Employing Silver Nanoparticles. BIOSENSORS 2023; 13:934. [PMID: 37887127 PMCID: PMC10605403 DOI: 10.3390/bios13100934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/29/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
Illicit drug misuse has become a widespread issue that requires continuous drug monitoring and diagnosis. Wearable electrochemical drug detection devices possess the potential to function as potent screening instruments in the possession of law enforcement personnel, aiding in the fight against drug trafficking and facilitating forensic investigations conducted on site. These wearable sensors are promising alternatives to traditional detection methods. In this study, we present a novel wearable electrochemical glove-based analytical device (eGAD) designed especially for detecting the club drug, methamphetamine. To develop this sensor, we immobilized meth aptamer onto silver nanoparticle (AgNPs)-modified electrodes that were printed onto latex gloves. The characteristics of AgNPs, including their shape, size and purity were analysed using FTIR, SEM and UV vis spectrometry, confirming the successful synthesis. The developed sensor shows a 0.1 µg/mL limit of detection and 0.3 µg/mL limit of quantification with a linear concentration range of about 0.01-5 µg/mL and recovery percentages of approximately 102 and 103%, respectively. To demonstrate its applicability, we tested the developed wearable sensor by spiking various alcoholic and non-alcoholic drink samples. We found that the sensor remains effective for 60 days, making it a practical option with a reasonable shelf-life. The developed sensor offers several advantages, including its affordability, ease of handling and high sensitivity and selectivity. Its portable nature makes it an ideal tool for rapid detection of METH in beverages too.
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Affiliation(s)
- Nigar Anzar
- Department of Biotechnology, School of Chemical and Life Science, Jamia Hamdard University, New Delhi 110062, India; (N.A.); (S.S.); (Y.S.)
| | - Shariq Suleman
- Department of Biotechnology, School of Chemical and Life Science, Jamia Hamdard University, New Delhi 110062, India; (N.A.); (S.S.); (Y.S.)
| | - Yashda Singh
- Department of Biotechnology, School of Chemical and Life Science, Jamia Hamdard University, New Delhi 110062, India; (N.A.); (S.S.); (Y.S.)
| | - Suhel Parvez
- Department of Toxicology, School of Chemical and Life Science, Jamia Hamdard University, New Delhi 110062, India;
| | - Manika Khanuja
- Centre for Nanoscience and Nanotechnology, Jamia Millia Islamia, New Delhi 110025, India;
| | - Roberto Pilloton
- Institute of Crystallography, National Research Council (CNR-IC), 00015 Rome, Italy
| | - Jagriti Narang
- Department of Biotechnology, School of Chemical and Life Science, Jamia Hamdard University, New Delhi 110062, India; (N.A.); (S.S.); (Y.S.)
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Kim M, Oh S, Kim S, Ji M, Choi B, Bae JW, Lee YS, Paik MJ, Lee S. Alcohol perturbed locomotor behavior, metabolism, and pharmacokinetics of gamma-hydroxybutyric acid in rats. Biomed Pharmacother 2023; 164:114992. [PMID: 37301134 DOI: 10.1016/j.biopha.2023.114992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
Gamma-hydroxybutyric acid (GHB), both a metabolic precursor and product of gamma-aminobutyric acid (GABA), is a central nervous system depressant used for the treatment of narcolepsy-associated cataplexy and alcohol withdrawal. However, administration of GHB with alcohol (ethanol) is a major cause of hospitalizations related to GHB intoxication. In this study, we investigated locomotor behavior as well as metabolic and pharmacokinetic interactions following co-administration of GHB and ethanol in rats. The locomotor behavior of rats was evaluated following the intraperitoneal administration of GHB (sodium salt, 500 mg/kg) and/or ethanol (2 g/kg). Further, time-course urinary metabolic profiling of GHB and its biomarker metabolites glutamic acid, GABA, succinic acid, 2,4-dihydroxybutyric acid (OH-BA), 3,4-OH-BA, and glycolic acid as well as pharmacokinetic analysis were performed. GHB/ethanol co-administration significantly reduced locomotor activity, compared to the individual administration of GHB or ethanol. The urinary and plasma concentrations of GHB and other target compounds, except for 2,4-OH-BA, were significantly higher in the GHB/ethanol co-administration group than the group administered only GHB. The pharmacokinetic analysis results showed that the co-administration of GHB and ethanol significantly increased the half-life of GHB while the total clearance decreased. Moreover, a comparison of the metabolite-to-parent drug area under the curve ratios demonstrated that the metabolic pathways of GHB, such α- and β-oxidation, were inhibited by ethanol. Consequently, the co-administration of GHB and ethanol aggravated the metabolism and elimination of GHB and enhanced its sedative effect. These findings will contribute to clinical interpretation of GHB intoxication.
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Affiliation(s)
- Mingyu Kim
- College of Pharmacy, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, the Republic of Korea
| | - Songjin Oh
- College of Pharmacy, Sunchon National University, 25 Jungang-ro, Suncheon 57922, the Republic of Korea
| | - Suji Kim
- College of Pharmacy, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, the Republic of Korea
| | - Moongi Ji
- College of Pharmacy, Sunchon National University, 25 Jungang-ro, Suncheon 57922, the Republic of Korea
| | - Byeongchan Choi
- College of Pharmacy, Sunchon National University, 25 Jungang-ro, Suncheon 57922, the Republic of Korea
| | - Jung-Woo Bae
- College of Pharmacy, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, the Republic of Korea
| | - Yong Sup Lee
- College of Pharmacy, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, the Republic of Korea
| | - Man-Jeong Paik
- College of Pharmacy, Sunchon National University, 25 Jungang-ro, Suncheon 57922, the Republic of Korea.
| | - Sooyeun Lee
- College of Pharmacy, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, the Republic of Korea.
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Ramirez-Cardenas A, Wingate KC, Pompei R, King B, Scott KA, Hagan-Haynes K, Chosewood LC. Fatalities Involving Substance Use Among US Oil and Gas Extraction Workers Identified Through an Industry Specific Surveillance System (2014-2019). J Occup Environ Med 2023; 65:488-494. [PMID: 36998177 PMCID: PMC11081204 DOI: 10.1097/jom.0000000000002856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
OBJECTIVE Characteristics of oil and gas extraction (OGE) work, including long hours, shiftwork, fatigue, physically demanding work, and job insecurity are risk factors for substance use among workers. Limited information exists examining worker fatalities involving substance use among OGE workers. METHODS The National Institute for Occupational Safety and Health's Fatalities in Oil and Gas Extraction database was screened for fatalities involving substance use from 2014 through 2019. RESULTS Twenty-six worker deaths were identified as involving substance use. Methamphetamine or amphetamine was the most common substances (61.5%) identified. Other contributing factors were lack of seatbelt use (85.7%), working in high temperatures (19.2%), and workers' first day with the company (11.5%). CONCLUSIONS Employer recommendations to mitigate substance use-related risks in OGE workers include training, medical screening, drug testing, and workplace supported recovery programs.
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Affiliation(s)
- Alejandra Ramirez-Cardenas
- From the Western States Division, National Institute for Occupational Safety and Health, Lakewood, Colorado (A.R.-C., K.C.W., B.K., K.A.S., K.H.-H.); Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, CU Anschutz, Aurora, Colorado (R.P.); Office of the Director, National Institute for Occupational Safety and Health, Atlanta, Georgia (L.C.C.)
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Qeadan F, Nicolson A, Barbeau WA, Azagba S, English K. The association between dual use of electronic nicotine products and illicit drugs with adverse cardiovascular and respiratory outcomes in a longitudinal analysis using the Population Assessment of Tobacco and Health (PATH) survey. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100166. [PMID: 37228861 PMCID: PMC10205457 DOI: 10.1016/j.dadr.2023.100166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/16/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
Background Drug use and electronic nicotine delivery systems (ENDS) are independently associated with increased risk of cardiovascular and respiratory outcomes. Literature on the association between the dual use of these key substances and potential health outcomes is limited. Methods We examined the association between dual use of ENDs and drugs (including heroin, methamphetamine, cocaine, painkillers, and misused stimulant medications) with adverse cardiovascular and respiratory outcomes in a longitudinal analysis using waves 1-5 from the Population Assessment of Tobacco and Health survey (2014-2018). Multivariable logistic regression with Generalized Estimating Equations was utilized. Results About 0.9% (n = 368) of respondents at wave 2 used both ENDS and drugs, 5.1% (n = 1,985) exclusively used ENDS, and 5.9% (n = 1,318) used drugs. Compared with people who do not use drugs, both those who used only ENDS (Adjusted Odds Ratio (AOR) 1.11 [95% CI 0.99-1.23], P = 0.07758) and those who used only drugs (AOR 1.36 [95% CI 1.15-1.60], P = 0.00027) were more likely to experience adverse respiratory conditions. Individuals who used drugs and ENDS compared to people who did not use drugs or ENDS had the largest odds of respiratory problems among all drug use category comparisons (AOR 1.52 [95% CI 1.20-1.93], P = 0.00054). Individuals who only used drugs had elevated odds of cardiovascular ailments compared to people who did not use drugs or ENDS (AOR 1.24 [95% CI 1.08-1.42], P = 0.00214) and compared to people who only used ENDS (AOR 1.22 [95% CI 1.04-1.42], P = 0.0117). Conclusions Inhaling electronic nicotine delivery systems and other substances may negatively affect the users' respiratory health.
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Affiliation(s)
- Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - Alexander Nicolson
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - William A. Barbeau
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - Sunday Azagba
- Nese College of Nursing, Penn State University, University Park, PA, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, NM, USA
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Jung S, Kim M, Kim S, Lee S. Interaction between γ-Hydroxybutyric Acid and Ethanol: A Review from Toxicokinetic and Toxicodynamic Perspectives. Metabolites 2023; 13:180. [PMID: 36837798 PMCID: PMC9965651 DOI: 10.3390/metabo13020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
Gamma-hydroxybutyric acid (GHB) is a potent, short-acting central nervous system depressant as well as an inhibitory neurotransmitter or neuromodulator derived from gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter. The sodium salt of GHB, sodium oxybate, has been used for the treatment of narcolepsy and cataplexy, whereas GHB was termed as a date rape drug or a club drug in the 1990s. Ethanol is the most co-ingested drug in acute GHB intoxication. In this review, the latest findings on the combined effects of GHB and ethanol are summarized from toxicokinetic and toxicodynamic perspectives. For this purpose, we mainly discussed the pharmacology and toxicology of GHB, GHB intoxication under alcohol consumption, clinical cases of the combined intoxication of GHB and ethanol, and previous studies on the toxicokinetic and toxicodynamic interactions between GHB and ethanol in humans, animals, and an in vitro model. The combined administration of GHB and ethanol enhanced sedation and cardiovascular dysfunction, probably by the additive action of GABA receptors, while toxicokinetic changes of GHB were not significant. The findings of this review will contribute to clinical and forensic interpretation related to GHB intoxication. Furthermore, this review highlights the significance of studies aiming to further understand the enhanced inhibitory effects of GHB induced by the co-ingestion of ethanol.
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Affiliation(s)
| | | | | | - Sooyeun Lee
- College of Pharmacy, Keimyung University, 1095 Dalgubeoldaero, Dalseo-gu, Daegu 42601, Republic of Korea
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Risk of somatic diseases in patients with eating disorders: the role of comorbid substance use disorders. Epidemiol Psychiatr Sci 2022; 31:e73. [PMID: 36245431 PMCID: PMC9583632 DOI: 10.1017/s204579602200052x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Eating disorders (EDs) and substance use disorders (SUDs) often co-occur, and both involve somatic diseases. So far, no study has considered whether comorbid SUDs may impact somatic disease risk in patients with EDs. Therefore, this study aimed to examine the impact of comorbid SUDs on the risk of 11 somatic disease categories in patients with anorexia nervosa (AN), bulimia nervosa (BN) and unspecified eating disorder (USED) compared to matched controls. METHODS A retrospective cohort study was conducted using Danish nationwide registries. The study population included 20 759 patients with EDs and 83 036 controls matched on month and year of birth, sex and ethnicity. Hazard ratios (HRs) were calculated to compare the risk of being diagnosed with a somatic disease (within 11 categories defined by the ICD-10) following first ED diagnosis (index date) between ED patients and controls both with and without SUDs (alcohol, cannabis or hard drugs). RESULTS The ED cohort and matched controls were followed for 227 538 and 939 628 person-years, respectively. For ED patients with SUDs, the risk pattern for being diagnosed with different somatic diseases (relative to controls without SUDs) varied according to type of ED and SUD [adjusted HRs ranged from 0.95 (99% CI = 0.57; 1.59) to 4.17 (2.68, 6.47)]. The risk estimates observed among ED patients with SUDs were generally higher than those observed among ED patients without SUDs [adjusted HRs ranged from 1.08 (99% CI = 0.95, 1.22) to 2.56 (2.31, 2.84)]. Abuse of alcohol only had a non-synergistic effect on six disease categories in AN patients and five in BN and USED patients. Abuse of cannabis (with/without alcohol) had a non-synergistic effect on five disease categories in AN and BN patients and two in USED patients. Abuse of hard drugs (with/without alcohol or cannabis) had a non-synergistic effect on nine disease categories in AN patients, eight in BN patients and seven in USED patients. CONCLUSIONS The present study documents non-synergistic but not synergistic harmful somatic consequences of SUDs among patients with different EDs, with AN and hard drugs being the most predominant factors. Hence, EDs and SUDs did not interact and result in greater somatic disease risk than that caused by the independent effects. Since EDs and SUDs have independent effects on many somatic diseases, it is important to monitor and treat ED patients for SUD comorbidity to prevent exacerbated physical damage in this vulnerable population.
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Edinoff AN, Ellis ED, Nussdorf LM, Hill TW, Cornett EM, Kaye AM, Kaye AD. Antipsychotic Polypharmacy-Related Cardiovascular Morbidity and Mortality: A Comprehensive Review. Neurol Int 2022; 14:294-309. [PMID: 35324580 PMCID: PMC8954521 DOI: 10.3390/neurolint14010024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Schizophrenia is a psychotic disorder that exists at the more extreme end of a spectrum of diseases, and significantly affects daily functioning. Cardiovascular adverse effects of antipsychotic medications are well known, and include changes in blood pressure and arrhythmias. Sudden cardiac death is the leading cause of death worldwide, and antipsychotic medications are associated with numerous cardiac side effects. A possible link exists between antipsychotic medications and sudden cardiac death. Common prescribing patterns that may influence cardiovascular events include the use of multiple antipsychotics and/or additional drugs commonly prescribed to patients on antipsychotics. The results of this review reflect an association between antipsychotic drugs and increased risk of ventricular arrhythmias and sudden cardiac death by iatrogenic prolongation of the QTc interval. QTc prolongation and sudden cardiac death exist in patients taking antipsychotic monotherapy. The risk increases for the concomitant use of specific drugs that prolong the QTc interval, such as opioids, antibiotics, and illicit drugs. However, evidence suggests that QTc intervals may not adequately predict sudden cardiac death. In considering the findings of this narrative review, we conclude that it is unclear whether there is a precise association between antipsychotic polypharmacy and sudden cardiac death with QTc interval changes. The present narrative review warrants further research on this important potential association.
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Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA
- Correspondence: ; Tel.: +1-(318)-675-8969
| | - Emily D. Ellis
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA 71103, USA; (E.D.E.); (L.M.N.); (T.W.H.)
| | - Laura M. Nussdorf
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA 71103, USA; (E.D.E.); (L.M.N.); (T.W.H.)
| | - Taylor W. Hill
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA 71103, USA; (E.D.E.); (L.M.N.); (T.W.H.)
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (E.M.C.); (A.D.K.)
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Gallagher JP, Twohig PA, Crnic A, Rochling FA. Illicit Drug Use and Endoscopy: When Do We Say No? Dig Dis Sci 2022; 67:5371-5381. [PMID: 35867192 PMCID: PMC9306238 DOI: 10.1007/s10620-022-07619-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/11/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Illicit drug use (IDU) is often encountered in patients undergoing elective ambulatory surgical procedures such as endoscopy. Given the variety of systemic effects of these drugs, sedation and anesthetics are believed to increase the risk of cardiopulmonary complications during procedures. Procedural cancelations are common, regardless of the drug type, recency of use, and total dosage consumed. There is a lack of institutional and society recommendations regarding the optimal approach to performing outpatient endoscopy on patients with IDU. AIM To review the literature for current recommendations regarding the optimal management of outpatient elective endoscopic procedures in patients with IDU. Secondary aim is to provide guidance for clinicians who encounter IDU in endoscopic practice. METHODS Systematic review of PubMed, CINAHL, Embase, and Google Scholar for articles presenting data on outcomes of elective procedures in patients using illicit drugs. RESULTS There are no clinically relevant differences in periprocedural complications or mortality in cannabis users compared to non-users. Endoscopy in patients with remote cocaine use was also found to have similar outcomes to recent use. CONCLUSIONS Canceling endoscopic procedures in patients with recent IDU without consideration of the type of drug, dosage, and chronicity may lead to unnecessary delays in care and increased patient morbidity. Healthcare systems would benefit from additional guidelines for evaluating the patient with recent illicit drug use for acute intoxication and consider proceeding with procedures in the non-toxic population.
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Affiliation(s)
- John P. Gallagher
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
| | - Patrick A. Twohig
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
| | - Agnes Crnic
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON K1Y 4E9 Canada
| | - Fedja A. Rochling
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
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Roberts DM, Premachandra KH, Chan BS, Auld R, Jiranantakan T, Ewers C, McDonald C, Shaw V, Brown JA. A cluster of lysergic acid diethylamide (LSD) poisonings following insufflation of a white powder sold as cocaine. Clin Toxicol (Phila) 2021; 59:969-974. [PMID: 33849370 DOI: 10.1080/15563650.2021.1904140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Adulteration, substitution or contamination of illicit substances can have clinically significant implications when other illicit substances are included. Such circumstances can present as clusters of poisonings, including severe toxicity and death following exposure to unexpected illicit substances. We report a cluster of laboratory-confirmed lysergic acid diethylamide (LSD) in a powder that was sold as cocaine and used recreationally. METHODS The Prescription, Recreational and Illicit Substance Evaluation (PRISE) program established by the New South Wales Ministry of Health includes State-based hospital toxicology services, Poisons Information Centre, Forensic & Analytical Science Service and emergency services to identify clusters of severe and unusual toxicity associated with substance use. PRISE criteria include a known cluster (geographically or situationally related) of people with acute severe toxicity, especially when accompanied by a toxidrome that is inconsistent with the history of exposure. A timely comprehensive drug screen and quantification is performed in eligible cases and the results are related to the clinical features. The need for a public health response is then considered. Four individuals inhaled a white powder that was sold as cocaine and developed severe toxicity that was not consistent with cocaine which prompted transfer to hospital for further management. RESULTS LSD was confirmed in four subjects, and the concentrations in 3 of the individuals were 0.04-0.06 mg/L which are among the highest reported in the literature. Common clinical features were hallucinations, agitation, vomiting, sedation, hypertension, and mydriasis. One subject required intubation and admission to the intensive care unit, two required overnight admission, and the fourth was discharged following oral diazepam after observation. No subject suffered persistent injury. CONCLUSIONS A close working relationship between pre-hospital emergency services, hospital-based clinical services, public health authorities, and analytical laboratories appears to be advantageous. Favourable clinical outcomes are observed from LSD poisoning despite high exposures with good supportive care.
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Affiliation(s)
- Darren M Roberts
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, Australia.,St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia.,NSW Poisons Information Centre, Sydney Children's Hospitals Network, Westmead, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Kulanka H Premachandra
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, Australia.,St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia
| | - Betty S Chan
- NSW Poisons Information Centre, Sydney Children's Hospitals Network, Westmead, Australia.,Clinical Toxicology Unit and Emergency Department, Prince of Wales Hospital, Randwick, Australia
| | - Robin Auld
- Centre for Alcohol and Other Drugs, NSW Ministry of Health, St Leonards, Australia
| | - Thanjira Jiranantakan
- NSW Poisons Information Centre, Sydney Children's Hospitals Network, Westmead, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia.,Centre for Alcohol and Other Drugs, NSW Ministry of Health, St Leonards, Australia.,Edith Collins Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christopher Ewers
- Illicit Drugs Analysis Unit, NSW Health Pathology, Forensic & Analytical Science Service, Lidcombe, Australia
| | - Catherine McDonald
- Forensic Toxicology, NSW Health Pathology, Forensic & Analytical Science Service, Lidcombe, Australia
| | - Vanessa Shaw
- Forensic Toxicology, NSW Health Pathology, Forensic & Analytical Science Service, Lidcombe, Australia
| | - Jared A Brown
- NSW Poisons Information Centre, Sydney Children's Hospitals Network, Westmead, Australia.,Centre for Alcohol and Other Drugs, NSW Ministry of Health, St Leonards, Australia
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Lapostolle F, Beaune S. Ecstasy : la deuxième vague…. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La molécule de MDMA (3,4-méthylènedioxyméthamphétamine ou ecstasy) a plus de 100 ans. Sa consommation a explosé dans les années 1990, essentiellement dans un cadre « festif » ou « récréatif ». Elle a ensuite considérablement diminué au début des années 2000 et connaît actuellement un regain d’intérêt certain. Sa consommation a volontiers été considérée comme anodine avant qu’il n’apparaisse clairement qu’elle pouvait provoquer des décès, en l’absence même de « surdose ». Les mécanismes de toxicité sont multiples, complexes et imparfaitement élucidés. L’interaction avec les principaux neuromédiateurs est certaine. L’ecstasy est classée dans les produits empathogènes. Sa consommation vise à favoriser les relations sociales. De nombreux effets secondaires sont possibles. Les conditions de consommation, en ambiance confinée, avec une activité physique soutenue et prolongée favorisent la survenue des effets secondaires. Les effets secondaires bénins sont tolérés et considérés comme étant le « prix à payer » dans la recherche des effets psychogènes. En raison de son tropisme, les principales complications de la consommation d’ecstasy sont psychiatriques et neurologiques, mais aussi cardiovasculaires, respiratoires et métaboliques. Cependant, les formes graves de l’intoxication sont marquées par un tableau d’hyperthermie maligne responsable de complications multiples et pouvant conduire au décès. Tous les auteurs insistent sur la possibilité de complications, de formes graves, voire de décès après la consommation d’une dose unique de MDMA. Il n’y a pas de traitement spécifique. Le traitement symptomatique est au premier plan. Hydratation et sédation sont les clés de ce traitement.
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Rivero-Echeto MC, Perissinotti PP, González-Inchauspe C, Kargieman L, Bisagno V, Urbano FJ. Simultaneous administration of cocaine and caffeine dysregulates HCN and T-type channels. Psychopharmacology (Berl) 2021; 238:787-810. [PMID: 33241481 PMCID: PMC7688300 DOI: 10.1007/s00213-020-05731-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
RATIONALE The abuse of psychostimulants has adverse consequences on the physiology of the central nervous system. In Argentina, and other South American countries, coca paste or "PACO" (cocaine and caffeine are its major components) is massively consumed with deleterious clinical consequences for the health and well-being of the general population. A scant number of studies have addressed the consequences of stimulant combination of cocaine and caffeine on the physiology of the somatosensory thalamocortical (ThCo) system. OBJECTIVES Our aim was to study ion conductances that have important implications regulating sleep-wake states 24-h after an acute or chronic binge-like administration of a cocaine and caffeine mixture following previously analyzed pasta base samples ("PACO"-like binge") using mice. METHODS We randomly injected (i.p.) male C57BL/6JFcen mice with a binge-like psychostimulants regimen during either 1 day (acute) or 1 day on/1 day off during 13 days for a total of 7 binges (chronic). Single-cell patch-clamp recordings of VB neurons were performed in thalamocortical slices 24 h after the last psychostimulant injection. We also recorded EEG/EMG from mice 24 h after being systemically treated with chronic administration of cocaine + caffeine versus saline, vehicle. RESULTS Our results showed notorious changes in the intrinsic properties of the VB nucleus neurons that persist after 24-h of either acute or chronic binge administrations of combined cocaine and caffeine ("PACO"-like binge). Functional dysregulation of HCN (hyperpolarization-activated cyclic nucleotide-gated) and T-type VGC (voltage-gated calcium) channels was described 24-h after acute/chronic "PACO"-like administrations. Furthermore, intracellular basal [Ca2+] disturbances resulted a key factor that modulated the availability and the activation of T-type channels, altering T-type "window currents." As a result, all these changes ultimately shaped the low-threshold spikes (LTS)-associated Ca2+ transients, regulated the membrane excitability, and altered sleep-wake transitions. CONCLUSION Our results suggest that deleterious consequences of stimulants cocaine and caffeine combination on the thalamocortical physiology as a whole might be related to potential neurotoxic effects of soaring intracellular [Ca2+].
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Affiliation(s)
- María Celeste Rivero-Echeto
- grid.7345.50000 0001 0056 1981CONICET-Universidad de Buenos Aires, Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), Ciudad de Buenos Aires, Argentina
| | - Paula P. Perissinotti
- grid.7345.50000 0001 0056 1981CONICET-Universidad de Buenos Aires, Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), Ciudad de Buenos Aires, Argentina
| | - Carlota González-Inchauspe
- grid.7345.50000 0001 0056 1981CONICET-Universidad de Buenos Aires, Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), Ciudad de Buenos Aires, Argentina
| | - Lucila Kargieman
- grid.7345.50000 0001 0056 1981CONICET-Universidad de Buenos Aires, Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), Ciudad de Buenos Aires, Argentina
| | - Verónica Bisagno
- grid.7345.50000 0001 0056 1981CONICET-Universidad de Buenos Aires, Instituto de Investigaciones Farmacológicas (ININFA), Ciudad de Buenos Aires, Argentina
| | - Francisco J. Urbano
- grid.7345.50000 0001 0056 1981CONICET-Universidad de Buenos Aires, Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), Ciudad de Buenos Aires, Argentina ,grid.7345.50000 0001 0056 1981Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Fisiología, Biología Molecular y Celular “Dr. Héctor Maldonado”, Ciudad de Buenos Aires, Argentina ,grid.7345.50000 0001 0056 1981IFIBYNE (UBA-CONICET), Intendente Güiraldes 2160, Ciudad Universitaria, C1428EGA Ciudad Autónoma de Buenos Aires, Argentina
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19
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Spontaneous Pneumomediastinum and Diffuse Subcutaneous Emphysema after Methamphetamine Inhalation. Case Rep Pulmonol 2020; 2020:7538748. [PMID: 32206367 PMCID: PMC7081024 DOI: 10.1155/2020/7538748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/24/2020] [Indexed: 11/17/2022] Open
Abstract
Methamphetamines are commonly abused drugs for their stimulant and euphoric effects. Inhaled and intravenous use may cause damage to the respiratory system. Spontaneous pneumomediastinum is a condition where changes in intrathoracic pressure leads to alveolar rupture and dissection of air along the tracheobronchial tree. Massive subcutaneous emphysema may result from pneumomediastinum which may compromise the central airway. In this case report, we present an unusual case of spontaneous pneumomediastinum and severe subcutaneous emphysema following inhalation of methamphetamine. This case emphasizes the rising concern on the acute respiratory complications of methamphetamine use.
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20
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Alcohol Intoxication-Related Soft Tissue Injuries in Patients With Orbital Wall Fractures. J Craniofac Surg 2019; 30:e646-e649. [PMID: 31449200 DOI: 10.1097/scs.0000000000005823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND To date, involvement of alcohol intoxication (AI) in the occurrence of traumatic bone injuries has been well described in the literature. Still, however, there is a paucity of data regarding its involvement with soft tissue injuries in the oral and maxillofacial region. Considering that it is one of the significant predisposing factors that are involved in facial bone fractures in assault victims, we have speculated that they are also vulnerable to soft tissue injuries. We therefore examined the incidence, type and, pattern of soft tissue injuries in patients with trauma owing to the AI in a single-institution setting. MATERIALS AND METHODS A total of 488 patients underwent reconstructive surgery for orbital wall fracture at our medical institution between 2012 and 2017. Of these, 162 eligible patients were enrolled in the present study; they were divided into 2 groups (the AI group and the control group) based on a history of the AI. Then, we compared baseline and clinical characteristics, including the incidence, type, and pattern of soft tissue injury, between the 2 groups. RESULTS In our series, assault was the most common cause of traumatic injuries. We found that the patients with AI were at increased risks of preoperatively developing subconjunctival hemorrhage and diplopia and postoperatively developing infraorbital nerve (ION) hypesthesia. CONCLUSIONS In conclusion, our results indicate that the AI is closely associated with the preoperative risks of subconjunctival hemorrhage and diplopia and the postoperative risks of ION hypesthesia. But further large-scale, multicenter studies are warranted to establish our results.
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21
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Ciriaco P, Rossetti F, Carretta A, Sant'Angelo M, Arrigoni G, Negri G. Spontaneous pneumothorax in cocaine users. QJM 2019; 112:519-522. [PMID: 30895319 DOI: 10.1093/qjmed/hcz070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/14/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pneumothorax is one of the respiratory toxic effects of cocaine inhalation. The literature counts several cases, some associated to other respiratory conditions such as pneumomediastinum, haemoptysis and others not requiring surgical treatment. AIM We present a series of nonHIV cocaine-inhaler subjects who underwent video-assisted thoracoscopic surgery (VATS) for isolated spontaneous pneumothorax. DESIGN Nine subjects, with a mean age of 24 ± 4 years, admitting cocaine inhalation, developed spontaneous pneumothorax and underwent 10 surgical treatments by means of VATS, at our Institution. RESULTS Previous pneumothorax occurred in six cases episodes ranged from 0 to 5 (mean 1.6 ± 1.6). Chest computed tomography (CT) scan showed abnormalities in seven cases. All subjects underwent lung apicectomy, apical pleurectomy and mechanical pleurodesis. Seven subjects had also bullectomy. In all cases the visceral pleura was partially covered by fibrinous exudate. Histology of the lung showed small foreign body granulomatous inflammation in fibrotic and/or emphysematous pulmonary parenchyma. Relapse of pneumothorax occurred in one subject at 60 days and it was surgically treated. Mean follow-up was 150 ± 38 months (range 120-239). All subjects are now well, with no evidence of pneumothorax. CONCLUSIONS Spontaneous pneumothorax in cocaine-inhaler subjects is a reality of which physicians need to be aware. Chest CT scan might not reveal abnormalities. Macroscopically the lung might presents bullae and/or peculiar visceral pleura. Foreign body granulomas observed in the specimens suggest that the particulate component of inhaled substances can injure the lung. Surgical treatment of the bullous disease and mechanical pleurodesis can provide a long-term follow-up without relapse of pneumothorax.
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Affiliation(s)
| | | | | | - M Sant'Angelo
- Department of Pathology, Scientific Institute and University Vita-Salute San Raffaele, Ospedale San Raffaele, Milan, Italy
| | - G Arrigoni
- Department of Pathology, Scientific Institute and University Vita-Salute San Raffaele, Ospedale San Raffaele, Milan, Italy
| | - G Negri
- Department of Thoracic Surgery
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Plenis A, Olędzka I, Kowalski P, Miękus N, Bączek T. Recent Trends in the Quantification of Biogenic Amines in Biofluids as Biomarkers of Various Disorders: A Review. J Clin Med 2019; 8:E640. [PMID: 31075927 PMCID: PMC6572256 DOI: 10.3390/jcm8050640] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 01/10/2023] Open
Abstract
Biogenic amines (BAs) are bioactive endogenous compounds which play a significant physiological role in many cell processes like cell proliferation and differentiation, signal transduction and membrane stability. Likewise, they are important in the regulation of body temperature, the increase/decrease of blood pressure or intake of nutrition, as well as in the synthesis of nucleic acids and proteins, hormones and alkaloids. Additionally, it was confirmed that these compounds can be considered as useful biomarkers for the diagnosis, therapy and prognosis of several neuroendocrine and cardiovascular disorders, including neuroendocrine tumours (NET), schizophrenia and Parkinson's Disease. Due to the fact that BAs are chemically unstable, light-sensitive and possess a high tendency for spontaneous oxidation and decomposition at high pH values, their determination is a real challenge. Moreover, their concentrations in biological matrices are extremely low. These issues make the measurement of BA levels in biological matrices problematic and the application of reliable bioanalytical methods for the extraction and determination of these molecules is needed. This article presents an overview of the most recent trends in the quantification of BAs in human samples with a special focus on liquid chromatography (LC), gas chromatography (GC) and capillary electrophoresis (CE) techniques. Thus, new approaches and technical possibilities applied in these methodologies for the assessment of BA profiles in human samples and the priorities for future research are reported and critically discussed. Moreover, the most important applications of LC, GC and CE in pharmacology, psychology, oncology and clinical endocrinology in the area of the analysis of BAs for the diagnosis, follow-up and monitoring of the therapy of various health disorders are presented and critically evaluated.
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Affiliation(s)
- Alina Plenis
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland.
| | - Ilona Olędzka
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland.
| | - Piotr Kowalski
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland.
| | - Natalia Miękus
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland.
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland.
| | - Tomasz Bączek
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland.
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Kovács K, Kereszty É, Berkecz R, Tiszlavicz L, Sija É, Körmöczi T, Jenei N, Révész-Schmehl H, Institóris L. Fatal intoxication of a regular drug user following N-ethyl-hexedrone and ADB-FUBINACA consumption. J Forensic Leg Med 2019; 65:92-100. [PMID: 31128567 DOI: 10.1016/j.jflm.2019.04.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/18/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Abstract
In Hungary, N-ethyl-hexedrone (NEH) was the most frequently seized stimulant designer drug in 2017, while among synthetic cannabinoids ADB-FUBINACA and AB-FUBINACA were the most popular. Symptoms of intoxication by these substances are well known but less is known about the pathology of overdose-related death. NEH-induced fatal intoxication has not been described in the literature and knowledge surrounding the particular circumstances of death could be useful better public education of risk and more adequate treatment of overdose patients. In this report, we characterize the case of a 23-year-old male regular drug user who died a few hours after NEH and ADB-FUBINACA consumption. His medical history showed arrhythmia in childhood, and some seizures. Autopsy found he had a BMI of 42.9, a hypertrophic and dilated heart, severe atherosclerosis of the valves, coronaries and the arteries, and edema of the internal organs. Histology confirmed those findings. Postmortem blood levels of NEH were 285 ng/ml, along with 0.08 ng/ml ADB-FUBINACA and five ADB-FUBINACA metabolites. Based on the blood concentrations measured in suspected drug users (≤83.9 ng/ml) we hypothesize that NEH intoxication was the cause of death in this case, with heart disease being a co-factor and that the synthetic cannabinoid effect might have been accompaniment. This case also offered the opportunity to identify the metabolites of ADB-FUBINACA in the blood. We identified metabolites in the post-mortem blood by comparing them to human liver microsomal enzyme metabolites in vitro. Three major and two minor metabolites were found in the blood, of which two could only be derived from ADB-FUBINACA, as opposed to other cannabinoids. The case highlights the importance of the complex analysis of drug related deaths by medico-legal autopsy, histopathology and toxicology.
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Affiliation(s)
- Katalin Kovács
- Department of Forensic Medicine, Faculty of Medicine, University of Szeged, Hungary
| | - Éva Kereszty
- Department of Forensic Medicine, Faculty of Medicine, University of Szeged, Hungary.
| | - Róbert Berkecz
- Department of Medical Chemistry, Faculty of Medicine, University of Szeged, Hungary
| | - László Tiszlavicz
- Department of Pathology, Faculty of Medicine, University of Szeged, Hungary
| | - Éva Sija
- Department of Forensic Medicine, Faculty of Medicine, University of Szeged, Hungary
| | - Tímea Körmöczi
- Department of Medical Chemistry, Faculty of Medicine, University of Szeged, Hungary
| | - Nikolett Jenei
- Department of Forensic Toxicology, Hungarian Institute for Forensic Sciences, Hungary
| | - Hajnal Révész-Schmehl
- Department of Forensic Toxicology, Hungarian Institute for Forensic Sciences, Hungary
| | - László Institóris
- Department of Forensic Medicine, Faculty of Medicine, University of Szeged, Hungary
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Schmith VD, Curd L, Lohmer LRL, Laffont CM, Andorn A, Young MA. Evaluation of the Effects of a Monthly Buprenorphine Depot Subcutaneous Injection on QT Interval During Treatment for Opioid Use Disorder. Clin Pharmacol Ther 2019; 106:576-584. [PMID: 30801681 PMCID: PMC6766787 DOI: 10.1002/cpt.1406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/13/2019] [Indexed: 12/19/2022]
Abstract
Extensive 12‐lead electrocardiogram monitoring and drug concentrations were obtained during development of BUP‐XR, a monthly subcutaneous injection for the treatment of opioid use disorder (OUD). Matched QT and plasma drug concentrations (11,925) from 1,114 subjects were pooled from 5 studies in OUD. A concentration‐QT model was developed, which accounted for confounding factors (e.g., comedications) affecting heart rate and heart rate‐corrected QT interval (QTc). Bias‐corrected nonparametric two‐sided 90% confidence intervals (CIs) were derived for the mean predicted effect of BUP‐XR on QTc (ΔQTc) at therapeutic and supratherapeutic doses. Changes in QTc were associated with age, central vs. noncentral reading, sex, methadone, and barbiturates. The upper 90% CI of ΔQTc was 0.29, 0.67, and 1.34 ms at the steady‐state peak concentration (Cmax) for 100, 300, and 2 × 300 mg doses, respectively. An effect of BUP‐XR on QT can be ruled out at therapeutic and supratherapeutic doses of BUP‐XR, after accounting for covariates that may influence heart rate and QT interval in OUD.
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Affiliation(s)
| | - Laura Curd
- Nuventra Pharma Sciences, Durham, North Carolina, USA
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Kunst LE, Gebhardt WA. Prevalence and Psychosocial Correlates of Party-Drug Use and Associated Problems among University Students in the Netherlands. Subst Use Misuse 2018; 53:2077-2088. [PMID: 29668345 DOI: 10.1080/10826084.2018.1455700] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Recent developments in drug use patterns call for an investigation of current party-drug use and associated problems among college students, who appear to be an important target population for harm reduction interventions. OBJECTIVES In addition to reporting on party-drug use prevalence, we investigated whether initial use and continuation of party-drug use among students was associated with demographic, personality and psychosocial factors. METHODS An online questionnaire was administered to 446 students from a Dutch university, inquiring about party-drug use, demographic characteristics, social norms and personality (big five, impulsiveness, aggression). Univariate and multivariate bootstrapped linear regression analyses were used. RESULTS Of all students, 22.9% indicated having used party-drugs at least once, with a notable sex difference (39.2% of men vs. 16.2% of women). In contrast to the reported trends in Dutch nightlife, GHB was used rarely (lifetime 1.6%) and new psychoactive substances (NPS; 6.7%) appeared almost equally popular as amphetamines (7.6%) and cocaine (7%). Mild health/psychosocial problems (e.g., doing embarrassing things, feeling unwell) were common (65%), whereas serious problems (e.g., being hospitalized) were rare. Neuroticism, extraversion, conscientiousness and impulsiveness were associated with lifetime but not regular party-drug use. Of all predictors, lifetime and regular party-drug use were most strongly related to lenient injunctive and descriptive norms in friends, and a low motivation to comply with parents. CONCLUSIONS Our findings indicate that harm reduction/preventive interventions might profit from focusing on social norms, and targeting students who are highly involved in a pro-party-drug environment while experiencing less parental influence.
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Affiliation(s)
- Laura E Kunst
- a Health, Medical and Neuropsychology Unit , Institute of Psychology, Leiden University , Leiden , The Netherlands.,b Department of Medical and Clinical Psychology , Tilburg School for Social and Behavioral Sciences, Tilburg University , Tilburg , The Netherland
| | - Winifred A Gebhardt
- a Health, Medical and Neuropsychology Unit , Institute of Psychology, Leiden University , Leiden , The Netherlands
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Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI, Van Gelder IC, Halle M, Kudaiberdieva G, Lane DA, Larsen TB, Lip GYH, Løchen ML, Marín F, Niebauer J, Sanders P, Tokgozoglu L, Vos MA, Van Wagoner DR, Fauchier L, Savelieva I, Goette A, Agewall S, Chiang CE, Figueiredo M, Stiles M, Dickfeld T, Patton K, Piepoli M, Corra U, Marques-Vidal PM, Faggiano P, Schmid JP, Abreu A. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace 2018; 19:190-225. [PMID: 28175283 DOI: 10.1093/europace/euw242] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | - Harry J Crijns
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, München, Germany
| | | | | | | | | | - Maja-Lisa Løchen
- University of Birmingham, Birmingham, UK.,Aalborg University Hospital, Aalborg, Denmark
| | | | - Josef Niebauer
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ugo Corra
- Irccs Rehabilitation Medical Center, Veruno, Italy
| | | | | | | | - Ana Abreu
- Hospital de Santa Marta, Lisboa, Portugal
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Marijuana use and short-term outcomes in patients hospitalized for acute myocardial infarction. PLoS One 2018; 13:e0199705. [PMID: 29995914 PMCID: PMC6040751 DOI: 10.1371/journal.pone.0199705] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
Marijuana use is increasing worldwide, and it is ever more likely that patients presenting with acute myocardial infarctions (AMI) will be marijuana users. However, little is known about the impact of marijuana use on short-term outcomes following AMI. Accordingly, we compared in-hospital outcomes of AMI patients with reported marijuana use to those with no reported marijuana use. We hypothesized that marijuana use would be associated with increased risk of adverse outcomes in AMI patients. Hospital records from 8 states between 1994–2013 were screened for patients with a diagnosis of AMI. Clinical profiles and outcomes in patients with reported use of marijuana were compared to patients without reported marijuana use. Short-term outcomes were defined as adverse events that occurred during hospitalization for an admitting diagnosis of AMI. The composite primary outcome included death, intraaortic balloon pump placement, (IABP), mechanical ventilation, cardiac arrest, and shock. In total, 3,854 of 1,273,897 AMI patients reported use of marijuana. The marijuana cohort was younger than (47.2 vs. 57.2, respectively) and had less coronary artery disease than the non-marijuana cohort. In multivariable analysis including age, race and common cardiac risk factors, there was no association between marijuana use and the primary outcome (p = 0.53), but marijuana users were more likely to be placed on mechanical ventilation (OR (odds ratio) 1.19, p = 0.004). Interestingly, marijuana-using patients were significantly less likely to die (OR 0.79, p = 0.016), experience shock (OR 0.74, p = 0.001), or require an IABP (OR 0.80, p = 0.03) post AMI than patients with no reported marijuana use. These results suggest that, contrary to our hypothesis, marijuana use was not associated with increased risk of adverse short-term outcomes following AMI. Furthermore, marijuana use was associated with decreased in-hospital mortality post-AMI.
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Colell E, Domingo-Salvany A, Espelt A, Parés-Badell O, Brugal MT. Differences in mortality in a cohort of cocaine use disorder patients with concurrent alcohol or opiates disorder. Addiction 2018; 113:1045-1055. [PMID: 29357115 DOI: 10.1111/add.14165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/21/2017] [Accepted: 01/12/2018] [Indexed: 12/24/2022]
Abstract
AIMS To study mortality in a cohort of cocaine use disorder patients, and compare results in those with concurrent alcohol or opiates disorder. DESIGN, SETTING AND PARTICIPANTS A cohort of 10 539 cocaine use disorder individuals entering drug treatment in public out-patient centres in the city of Barcelona was followed from 1997 to 2011. Participants were divided at baseline into three groups: those with only cocaine use disorder (CUD), those with cocaine and alcohol use disorder but not opioid (CAUD) and those with cocaine and opioid use disorder (COUD). Mortality was assessed through the Spanish National Mortality Register. MEASUREMENTS Crude mortality rates (CMR), standardized mortality ratios (SMR) and rate ratios (RR) were calculated for each group. A multivariable Cox regression model was fitted to obtain adjusted mortality hazard ratios (aHR) of CAUD and COUD with respect to CUD. Specific mortality causes were also examined. FINDINGS The total of 716 deaths registered resulted in a CMR = 6.0/1000 person-years (PY); 95% confidence interval (CI) = 5.1-7.0 for CUD, CMR = 5.8/1000 PY (95% CI = 4.9-6.7) for CAUD and CMR = 20.7/1000 PY (95% CI = 18.8-22.8) for COUD, with no significant differences among sexes. Compared with the general population, mortality was four times higher (SMR = 4.1, 95% CI = 3.5-4.8) among CUD, more than three times among CAUD (SMR = 3.4, 95% CI = 2.9-3.9) and more than 10 times among COUD (SMR = 11.6, 95% CI = 10.5-12.8), being always higher in women. External injuries, led by overdose, accumulated the biggest percentage of deaths among the three groups, but infectious diseases showed the highest excess mortality. Some differences regarding causes of death were observed between the three groups. CONCLUSIONS Mortality risk and excess mortality are significantly greater among those with cocaine and opiates use disorder than among people with only cocaine use disorder or cocaine and alcohol use disorder.
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Affiliation(s)
- Esther Colell
- Drug Abuse Epidemiology Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Antònia Domingo-Salvany
- Drug Abuse Epidemiology Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Albert Espelt
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain.,Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Bellaterra, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Biomedical Research Centre Network for Epidemiology and Public Health (Spain), Madrid, Spain.,Facultat de Ciències de la Salut de Manresa, Universitat de Vic. Universitat Central de Catalunya (UVicUCC), Av Universitària, Manresa, Spain
| | - Oleguer Parés-Badell
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain
| | - M Teresa Brugal
- Public Health Agency of Barcelona, Spain.,Institute of Biomedical Research Sant Pau, Barcelona, Spain
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Escobar M, Scherer JN, Soares CM, Guimarães LSP, Hagen ME, von Diemen L, Pechansky F. Active Brazilian crack cocaine users: nutritional, anthropometric, and drug use profiles. ACTA ACUST UNITED AC 2018; 40:354-360. [PMID: 29451589 PMCID: PMC6899369 DOI: 10.1590/1516-4446-2017-2409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/07/2017] [Indexed: 11/29/2022]
Abstract
Objective: To evaluate the nutritional status of crack users and to analyze its correlation with drug use profiles. Methods: Cross-sectional study with 108 crack users. Anthropometric data were assessed through body mass index (BMI) and bioimpedance (BIA) measurements. A blood test to analyze hematocrit, hemoglobin, glucose, and lipid profiles was also performed. Crack use was determined through a standardized interview. Results: Based on BMI and BIA, most individuals were eutrophic (about 70%). Regarding hematological parameters, we found that hemoglobin and hematocrit levels were below normal for 32.4 and 30.6% of patients, respectively. Considering normal parameters, a large part of the sample (60.2%) had low levels of HDL cholesterol and high levels of triglycerides (38%). There were no significant correlations between drug profile and nutritional variables. Conclusion: This is a pioneering study that examines the nutritional status of crack users. Our results showed that most crack users present normal anthropometric findings and the prevalence of underweight is low. However, blood analysis showed changes and a specific type of malnutrition.
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Affiliation(s)
- Mariana Escobar
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil.,Departamento de Nutrição, Centro de Estudos em Alimentação e Nutrição (CESAN), Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | - Juliana N Scherer
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Cassia M Soares
- Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | | | - Martine E Hagen
- Departamento de Nutrição, Centro de Estudos em Alimentação e Nutrição (CESAN), Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Centro de Pesquisa em Álcool e Drogas, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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30
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Hondebrink L, Zwartsen A, Westerink RHS. Effect fingerprinting of new psychoactive substances (NPS): What can we learn from in vitro data? Pharmacol Ther 2017; 182:193-224. [PMID: 29097307 DOI: 10.1016/j.pharmthera.2017.10.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The use of new psychoactive substances (NPS) is increasing and currently >600 NPS have been reported. However, limited information on neuropharmacological and toxicological effects of NPS is available, hampering risk characterization. We reviewed the literature on the in vitro neuronal modes of action to obtain effect fingerprints of different classes of illicit drugs and NPS. The most frequently reported NPS were selected for review: cathinones (MDPV, α-PVP, mephedrone, 4-MEC, pentedrone, methylone), cannabinoids (JWH-018), (hallucinogenic) phenethylamines (4-fluoroamphetamine, benzofurans (5-APB, 6-APB), 2C-B, NBOMes (25B-NBOMe, 25C-NBOMe, 25I-NBOMe)), arylcyclohexylamines (methoxetamine) and piperazine derivatives (mCPP, TFMPP, BZP). Our effect fingerprints highlight the main modes of action for the different NPS studied, including inhibition and/or reversal of monoamine reuptake transporters (cathinones and non-hallucinogenic phenethylamines), activation of 5-HT2receptors (hallucinogenic phenethylamines and piperazines), activation of cannabinoid receptors (cannabinoids) and inhibition of NDMA receptors (arylcyclohexylamines). Importantly, we identified additional targets by relating reported effect concentrations to the estimated human brain concentrations during recreational use. These additional targets include dopamine receptors, α- and β-adrenergic receptors, GABAAreceptors and acetylcholine receptors, which may all contribute to the observed clinical symptoms following exposure. Additional data is needed as the number of NPS continues to increase. Also, the effect fingerprints we have obtained are still incomplete and suffer from a large variation in the reported effects and effect sizes. Dedicated in vitro screening batteries will aid in complementing specific effect fingerprints of NPS. These fingerprints can be implemented in the risk assessments of NPS that are necessary for eventual control measures to reduce Public Health risks.
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Affiliation(s)
- Laura Hondebrink
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Anne Zwartsen
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht University, The Netherlands; Neurotoxicology Research Group, Division Toxicology, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80.177, NL-3508 TD, Utrecht, The Netherlands
| | - Remco H S Westerink
- Neurotoxicology Research Group, Division Toxicology, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80.177, NL-3508 TD, Utrecht, The Netherlands.
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Abstract
BACKGROUND Ecstasy is a widely used psychoactive drug that users often take because they experience positive effects such as increased euphoria, sociability, elevated mood, and heightened sensations. Ecstasy use is not harmless and several immediate and long term side effects have been identified. Lifetime ecstasy use is likely to be partly influenced by genetic factors, but no twin study has determined the heritability. Here, we apply a classical twin design to a large sample of twins and siblings to estimate the heritability of lifetime ecstasy use. METHODS The sample comprised 8500 twins and siblings aged between 18 and 45 years from 5402 families registered at the Netherlands Twin Registry. In 2013-2014 participants filled out a questionnaire including a question whether they had ever used ecstasy. We used the classical twin design to partition the individual differences in liability to ecstasy use into that due to genetic, shared environmental, and residual components. RESULTS Overall, 10.4% of the sample had used ecstasy during their lifetime, with a somewhat higher prevalence in males than females. Twin modelling indicated that individual differences in liability to lifetime ecstasy use are for 74% due to genetic differences between individuals, whereas shared environmental and residual factors explain a small proportion of its liability (5% and 21%, respectively). Although heritability estimates appeared to be higher for females than males, this difference was not significant. CONCLUSIONS Lifetime ecstasy use is a highly heritable trait, which indicates that some people are genetically more vulnerable to start using ecstasy than others.
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Pavarin RM, Fioritti A. Mortality Trends among Cocaine Users Treated between 1989 and 2013 in Northern Italy: Results of a Longitudinal Study. J Psychoactive Drugs 2017; 50:72-80. [PMID: 28846059 DOI: 10.1080/02791072.2017.1365976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A total of 852 participants attending 11 centers for addiction treatment in north Italy following problems due to cocaine abuse between 1989 and 2013 were recruited. Two typologies were created: cocaine users (never heroin) (CU) and heroin and cocaine users (HCU). During the 38-year follow-up period, 4.8% of the whole cohort died. Over the whole period, tumors were the main causes of death; starting in 2010, suicide deaths became the first cause of death. Among CUs, most deaths were due to road accidents and suicide; among HCUs, most of the deaths were from opiate overdose and from cardio-circulatory system diseases. The excess mortality observed for all causes in either sex was 6.24; higher in females (15.03) as compared in males (6.23), higher in HCUs (9.06) as compared in CUs (5.21). The directly age-sex standardized mortality rates were 5.31 per 100, higher for females, declining after 2009 for all patients and after 2004 for HCUs. Multivariate analysis confirms the decreasing trend in the risk of death and shows a higher mortality risk for participants in the under-25 age group. Among cocaine users, special attention should be paid to the prevention of suicide deaths.
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Affiliation(s)
- Raimondo Maria Pavarin
- a Doctor, Health Sociologist, and Chief of Epidemiological Monitoring Center on Addiction, Mental Health DSM-DP , Azienda USL, Bologna , Italy
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33
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Shi Q, Yang X, Greenhaw JJ, Salminen AT, Russotti GM, Salminen WF. Drug-Induced Liver Injury in Children: Clinical Observations, Animal Models, and Regulatory Status. Int J Toxicol 2017; 36:365-379. [PMID: 28820004 DOI: 10.1177/1091581817721675] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Drug-induced liver injury in children (cDILI) accounts for about 1% of all reported adverse drug reactions throughout all age groups, less than 10% of all clinical DILI cases, and around 20% of all acute liver failure cases in children. The overall DILI susceptibility in children has been assumed to be lower than in adults. Nevertheless, controversial evidence is emerging about children's sensitivity to DILI, with children's relative susceptibility to DILI appearing to be highly drug-specific. The culprit drugs in cDILI are similar but not identical to DILI in adults (aDILI). This is demonstrated by recent findings that a drug frequently associated with aDILI (amoxicillin/clavulanate) was rarely associated with cDILI and that the drug basiliximab caused only cDILI but not aDILI. The fatality in reported cDILI studies ranged from 4% to 31%. According to the US Food and Drug Administration-approved drugs labels, valproic acid, dactinomycin, and ampicillin appear more likely to cause cDILI. In contrast, deferasirox, isoniazid, dantrolene, and levofloxacin appear more likely to cause aDILI. Animal models have been explored to mimic children's increased susceptibility to valproic acid hepatotoxicity or decreased susceptibility to acetaminophen or halothane hepatotoxicity. However, for most drugs, animal models are not readily available, and the underlying mechanisms for the differential reactions to DILI between children and adults remain highly hypothetical. Diagnosis tools for cDILI are not yet available. A critical need exists to fill the knowledge gaps in cDILI. This review article provides an overview of cDILI and specific drugs associated with cDILI.
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Affiliation(s)
- Qiang Shi
- 1 Division of Systems Biology, National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR, USA
| | - Xi Yang
- 1 Division of Systems Biology, National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR, USA
| | - James J Greenhaw
- 1 Division of Systems Biology, National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR, USA
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Rozas JL, Goitia B, Bisagno V, Urbano FJ. Differential alterations of intracellular [Ca 2+] dynamics induced by cocaine and methylphenidate in thalamocortical ventrobasal neurons. ACTA ACUST UNITED AC 2017; 2. [PMID: 28920083 DOI: 10.15761/tbr.1000114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ventrobasal (VB) thalamus relay nucleus processes information from rodents' whiskers, projecting to somatosensory cortex. Cocaine and methylphenidate (MPH) have been described to differentially alter intrinsic properties of, and spontaneous GABAergic input to, VB neurons. Here we studied using bis-fura 2 ratiometric fluorescence the effects of cocaine and MPH on intracellular [Ca2+] dynamics at the soma and dendrites of VB neurons. Cocaine increased baseline fluorescence in VB somatic and dendritic compartments. Peak and areas of fluorescence amplitudes were reduced by cocaine binge treatment in somas and dendrites at different holding potentials. MPH binge treatment did not alter ratiometric fluorescence at either somatic or dendritic levels. These novel cocaine-mediated blunting effects on intracellular [Ca2+] might account for alterations in the capacity of thalamocortical neurons to maintain gamma band oscillations, as well as their ability to integrate synaptic afferents.
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Affiliation(s)
- José L Rozas
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Fisiología, Biología Molecular y Celular "Dr. Héctor Maldonado", Ciudad Autónoma de Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), Ciudad Autónoma de Buenos Aires
| | - Belén Goitia
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Fisiología, Biología Molecular y Celular "Dr. Héctor Maldonado", Ciudad Autónoma de Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), Ciudad Autónoma de Buenos Aires
| | - Verónica Bisagno
- Universidad de Buenos Aires, Farmacia y Bioquímica, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Instituto de Investigaciones Farmacológicas (ININFA), Ciudad Autónoma de Buenos Aires, Argentina
| | - Francisco J Urbano
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Fisiología, Biología Molecular y Celular "Dr. Héctor Maldonado", Ciudad Autónoma de Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), Ciudad Autónoma de Buenos Aires
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35
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Stoutenberg M, Rethorst CD, Vidot DC, Greer TL, Trivedi MH. Cardiorespiratory fitness and body composition of stimulant users: A baseline analysis of the STRIDE cohort. J Subst Abuse Treat 2017; 78:74-79. [PMID: 28554607 DOI: 10.1016/j.jsat.2017.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Relatively little has been reported about the physical characteristics, such as cardiorespiratory fitness (CRF) and body composition, of stimulant users. Identifying risk factors associated with the physical health of stimulant users is an important public health issue as new treatments should better address the entire range of health concerns experienced by this population. METHODS We examined cross-sectional data gathered at baseline from the STimulant Reduction Intervention using Dosed Exercise (STRIDE) study, a multisite randomized clinical trial that examined exercise as an adjunct to treatment as usual for individuals in residential treatment programs (RTPs). Clients were approached after intake to the RTP. Prior to randomization, eligible individuals underwent a comprehensive screening process that included medical screening, where CRF was assessed through a maximal exercise test (time on treadmill), and a series of baseline examinations assessing domains of substance use and mental health. RESULTS Data from 295 individuals with recent stimulant use disorders were analyzed. The mean body mass index (BMI) and waist circumference (WC) and for all participants was 27.8±5.7kg/m2 and 93.5±14.2cm, respectively, while the mean time on treadmill was 13.7±2.9min. Few significant associations were observed between CRF, BMI, or WC and substance use and mental health measures. CONCLUSIONS Stimulant users in this study presented with low CRF levels and would be considered overweight based on their BMI. These individuals would likely benefit from interventions that address both their stimulant use, as well as their physical health.
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Affiliation(s)
- Mark Stoutenberg
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - Chad D Rethorst
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Denise C Vidot
- School of Nursing & Health Studies, University of Miami, Coral Gables, FL, United States
| | - Tracy L Greer
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Albanese J, Gross C, Azab M, Mahalean S, Makar R. Spontaneous pneumomediastinum: A rare complication of methamphetamine use. Respir Med Case Rep 2017; 21:25-26. [PMID: 28348951 PMCID: PMC5358944 DOI: 10.1016/j.rmcr.2017.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 03/07/2017] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To present an unusual case of spontaneous pneumomediastinum subsequent to recreational amphetamine use. CASE REPORT A young African American adult male was admitted to internal medicine service for treatment of rhabdomyolysis secondary to methamphetamine use. On admission, he was complaining of chest pain in addition to nausea and generalized muscle aches. By his second hospital day, chest pain had resolved yet physical exam demonstrated crepitation of the anterior chest and left axilla. Portable chest x-ray revealed subcutaneous emphysema in addition to pneumomediastinum. CONCLUSION Spontaneous pneumomediastinum is a rare complication of amphetamine use that is often associated with subcutaneous emphysema and can be diagnosed with chest x-ray. Management is conservative, with observation, pain control, and supplemental oxygen as needed.
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Affiliation(s)
- Jessica Albanese
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Cole Gross
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Mohamed Azab
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Sinziana Mahalean
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Ranjit Makar
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, USA
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Abstract
Myocardial infarction (MI) is a term used for an event of heart attack which is due to formation of plaques in the interior walls of the arteries resulting in reduced blood flow to the heart and injuring heart muscles because of lack of oxygen supply. The symptoms of MI include chest pain, which travels from left arm to neck, shortness of breath, sweating, nausea, vomiting, abnormal heart beating, anxiety, fatigue, weakness, stress, depression, and other factors. The immediate treatment of MI include, taking aspirin, which prevents blood from clotting, and nitro-glycerin to treat chest pain and oxygen. The heart attack can be prevented by taking an earlier action to lower those risks by controlling diet, fat, cholesterol, salt, smoking, nicotine, alcohol, drugs, monitoring of blood pressure every week, doing exercise every day, and loosing body weight. The treatment of MI includes, aspirin tablets, and to dissolve arterial blockage injection of thrombolytic or clot dissolving drugs such as tissue plasminogen activator, streptokinase or urokinase in blood within 3 h of the onset of a heart attack. The painkillers such as morphine or meperidine can be administered to relieve pain. Nitroglycerin and antihypertensive drugs such as beta-blockers, ACE inhibitors or calcium channel blockers may also be used to lower blood pressure and to improve the oxygen demand of heart. The ECG, coronary angiography and X-ray of heart and blood vessels can be performed to observe the narrowing of coronary arteries. In this article the causes, symptoms and treatments of MI are described.
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Affiliation(s)
- Lei Lu
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Min Liu
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - RongRong Sun
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Yi Zheng
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Peiying Zhang
- Department of Cardiology, Xuzhou Central Hospital, 199# South Jiefang Road, Xuzhou, 221009, Jiangsu, China. .,Affiliated Xuzhou Hospital, Medical School of Southeast University, Xuzhou, 221009, Jiangsu, China. .,Xuzhou Clinical Medical College of Nanjing University of Chinese Medicine, Xuzhou, 221009, Jiangsu, China.
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Reece AS, Norman A, Hulse GK. Acceleration of cardiovascular-biological age by amphetamine exposure is a power function of chronological age. HEART ASIA 2017; 9:30-38. [PMID: 28243315 DOI: 10.1136/heartasia-2016-010832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/05/2016] [Accepted: 11/07/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Amphetamine abuse is becoming more widespread internationally. The possibility that its many cardiovascular complications are associated with a prematurely aged cardiovascular system, and indeed biological organism systemically, has not been addressed. METHODS Radial arterial pulse tonometry was performed using the SphygmoCor system (Sydney). 55 amphetamine exposed patients were compared with 107 tobacco smokers, 483 non-smokers and 68 methadone patients (total=713 patients) from 2006 to 2011. A cardiovascular-biological age (VA) was determined. RESULTS The age of the patient groups was 30.03±0.51-40.45±1.15 years. This was controlled for with linear regression. The sex ratio was the same in all groups. 94% of amphetamine exposed patients had used amphetamine in the previous week. When the (log) VA was regressed against the chronological age (CA) and a substance-type group in both cross-sectional and longitudinal models, models quadratic in CA were superior to linear models (both p<0.02). When log VA/CA was regressed in a mixed effects model against time, body mass index, CA and drug type, the cubic model was superior to the linear model (p=0.001). Interactions between CA, (CA)2 and (CA)3 on the one hand and exposure type were significant from p=0.0120. The effects of amphetamine exposure persisted after adjustment for all known cardiovascular risk factors (p<0.0001). CONCLUSIONS These results show that subacute exposure to amphetamines is associated with an advancement of cardiovascular-organismal age both over age and over time, and is robust to adjustment. That this is associated with power functions of age implies a feed-forward positively reinforcing exacerbation of the underlying ageing process.
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Affiliation(s)
- Albert Stuart Reece
- School of Psychiatry and Clinical Neurosciences , University of Western Australia , Crawley, Western Australia , Australia
| | - Amanda Norman
- School of Psychiatry and Clinical Neurosciences , University of Western Australia , Crawley, Western Australia , Australia
| | - Gary Kenneth Hulse
- School of Psychiatry and Clinical Neurosciences , University of Western Australia , Crawley, Western Australia , Australia
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Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI, Van Gelder IC, Halle M, Kudaiberdieva G, Lane DA, Bjerregaard Larsen T, Lip GYH, Løchen ML, Marin F, Niebauer J, Sanders P, Tokgozoglu L, Vos MA, Van Wagoner DR, Fauchier L, Savelieva I, Goette A, Agewall S, Chiang CE, Figueiredo M, Stiles M, Dickfeld T, Patton K, Piepoli M, Corra U, Manuel Marques-Vidal P, Faggiano P, Schmid JP, Abreu A. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Eur J Prev Cardiol 2017; 24:4-40. [PMID: 27815538 PMCID: PMC5427484 DOI: 10.1177/2047487316676037] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | | | - Harry J Crijns
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, München, Germany
| | | | | | | | | | - Maja-Lisa Løchen
- UiT The Arctic University of Norway, Tromso, Norway
- Mary MacKillop Institute for Health Research, Centre for Research Excellence to Reduce Inequality in Heart Disease, Australian Catholic University, Melbourne, Australia
| | | | - Josef Niebauer
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ugo Corra
- Irccs Rehabilitation Medical Center, Veruno, Italy
| | | | | | | | - Ana Abreu
- Hospital de Santa Marta, Lisboa, Portugal
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Kohut SJ. Interactions between nicotine and drugs of abuse: a review of preclinical findings. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:155-170. [PMID: 27589579 DOI: 10.1080/00952990.2016.1209513] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Polysubstance abuse is common among substance-use disorder patients, and nicotine is one of the most commonly co-used substances. Epidemiological and clinical laboratory studies suggest that nicotine, when combined with other drugs of abuse, increases intake of one or both substances. This review focuses on the preclinical literature regarding nicotine's interaction with alcohol, stimulants (i.e., cocaine, amphetamines), opioids (i.e., morphine, heroin), and Δ9-tetrahydrocannabinol (THC). The current understanding of how these various classes of abused drugs may interact with nicotine on behavioral, physiological, and pharmacological indices that may be important in maintaining co-use of one or both substances in human populations are highlighted. Suggestions as to future areas of research and gaps in knowledge are offered.
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Affiliation(s)
- Stephen J Kohut
- a McLean Hospital and Department of Psychiatry, Harvard Medical School , Belmont , MA , USA
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Carrà G, Crocamo C, Bartoli F, Lax A, Tremolada M, Lucii C, Martinotti G, Nosè M, Bighelli I, Ostuzzi G, Castellazzi M, Clerici M, Barbui C. First-generation antipsychotics and QTc: any role for mediating variables? Hum Psychopharmacol 2016; 31:313-8. [PMID: 27245736 DOI: 10.1002/hup.2540] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/31/2016] [Accepted: 04/21/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Corrected QT (QTc) interval prolongation is often associated with use of first-generation antipsychotics (FGAs). However, other factors require appropriate consideration, including age and gender, the role of other known medications associated with QTc prolongation, and severe comorbid conditions, such as co-occurring alcohol abuse/dependence. We aimed to study potential mediating roles of different, related, candidate variables on QTc. METHODS We capitalized on data from a large (N = 2366), cross-sectional, national survey, the STAR Network QTc study, using a representative sample of people taking FGAs, and recruited from mental health services across Italy. RESULTS About one-third of the sample was treated with FGAs, and almost one-tenth of the subjects took a different, additional, drug known to cause QTc prolongation. Our findings confirmed that there is an impact from FGAs, age, gender, alcohol misuse, and concurrent risky drugs on QTc. However, comorbid alcohol abuse/dependence and concurrent risky drugs did not mediate the effect of FGAs on QTc. CONCLUSIONS Our findings showed that FGAs, concurrent risky drugs, and alcohol use disorders prolonged QTc. FGAs had a direct effect on QTc, confirming the need for clinicians to monitor a risk that could lead to sudden unexplained death. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry, University College London, London, UK.,Department of Medicine and Surgery, University of Milano Bicocca, Monza (MB), Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Monza (MB), Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Monza (MB), Italy
| | - Annamaria Lax
- Department of Medicine and Surgery, University of Milano Bicocca, Monza (MB), Italy
| | - Martina Tremolada
- Department of Medicine and Surgery, University of Milano Bicocca, Monza (MB), Italy
| | | | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Michela Nosè
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Irene Bighelli
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Mariasole Castellazzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza (MB), Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
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Margret CP, Ries RK. Assessment and Treatment of Adolescent Substance Use Disorders: Alcohol Use Disorders. Child Adolesc Psychiatr Clin N Am 2016; 25:411-30. [PMID: 27338964 DOI: 10.1016/j.chc.2016.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Alcohol drinking in childhood and adolescence is a serious public health concern. Adolescence is a vulnerable period for risk-taking tendencies. Understanding the influences of problematic alcohol use is important for evolving interventions. Alcohol use in early years foreshadows a lifetime risk for psychiatric and substance use disorders. Early screening and assessment can alter tragic sequelae. We discuss clinical aspects such as confidentiality, differential levels of care, and criteria for best fitting treatments. Given the prevalence of drinking and its impact on psychiatric and substance use disorders, the need for further study and prevention are emphasized.
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Affiliation(s)
- Cecilia Patrica Margret
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle Children's Hospital, 4575 Sand Point Way Northeast, Suite 105, Seattle, WA 98105, USA.
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, 401 Broadway, 1st floor, Seattle, WA 98104, USA
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Wang DW, Liu M, Wang P, Zhan X, Liu YQ, Zhao LS. ADRB2 polymorphisms predict the risk of myocardial infarction and coronary artery disease. Genet Mol Biol 2015; 38:433-43. [PMID: 26692153 PMCID: PMC4763328 DOI: 10.1590/s1415-475738420140234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 04/27/2015] [Indexed: 12/03/2022] Open
Abstract
Recently, the rs1042713 G > A and rs1042714 C > G polymorphisms in the beta-2
adrenergic receptor (ADRB2) gene were shown to be related to atherosclerosis
diseases. Therefore, we performed a systemic meta-analysis to determine whether the
two functional polymorphisms are related to the risk of myocardial infarction (MI)
and coronary artery disease (CAD). We identified published studies that are relevant
to our topic of interest. Seven case-control studies, with a total of 6,843 subjects,
were incorporated into the current meta-analysis. Our analysis showed a higher
frequency of rs1042713 G > A variant in patients with MI or CAD compared to
healthy controls. A similar result was also obtained with the rs1042714 C > G
variant under both the allele and dominant models. Ethnicity-stratified subgroup
analysis suggested that the rs1042714 C > G variant correlated with an increased
risk of the two diseases in both Asians and Caucasians, while rs1042713 G > A only
contributes to the risk of two diseases in Asians. In the disease type-stratified
subgroups, the frequencies of both the rs1042713 G > A and rs1042714 C > G
variants were higher in the cases than in the controls in both the MI and CAD
subgroups. Collectively, our data contribute towards understanding the correlation
between the rs1042713 G > A and rs1042714 C > G polymorphisms in
ADRB2 and the susceptibility to MI and CAD.
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Affiliation(s)
- Dong-Wei Wang
- Department of Cardiology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, P.R. China
| | - Min Liu
- Department of Cardiology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, P.R. China
| | - Ping Wang
- Department of Cardiology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, P.R. China
| | - Xiang Zhan
- Department of Cardiology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, P.R. China
| | - Yu-Qing Liu
- Department of Cardiology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, P.R. China
| | - Luo-Sha Zhao
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
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Hunter A, Holdsworth DA, D'Arcy J, Bailey K, Casadei B. Hypertension in the military patient. J ROY ARMY MED CORPS 2015; 161:200-5. [PMID: 26253125 DOI: 10.1136/jramc-2015-000506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 11/04/2022]
Abstract
Hypertension and hypertension-related diseases are a leading cause of morbidity and mortality worldwide. A diagnosis of hypertension can have serious occupational implications for military personnel. This article examines the diagnosis and management of hypertension in military personnel, in the context of current international standards. We consider the consequences of hypertension in the military environment and potential military-specific issues relating to hypertension.
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Affiliation(s)
- Alys Hunter
- MDHU Portsmouth, Queen Alexandra Hospital, Portsmouth, UK
| | - D A Holdsworth
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - J D'Arcy
- RCDM (Oxford), John Radcliffe Hospital, Oxford, UK
| | - K Bailey
- AMD, Marlborough Lines, Andover, UK
| | - B Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Subcutaneous Emphysema, Pneumomediastinum, and Pneumorrhachis after Cocaine Inhalation. Case Rep Emerg Med 2015; 2015:134816. [PMID: 26236511 PMCID: PMC4510117 DOI: 10.1155/2015/134816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/14/2015] [Accepted: 06/15/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction. The most prominent complications of cocaine use are adverse effects in the cardiovascular and central nervous systems. Free air in the mediastinum and subcutaneous tissue may be observed less frequently, whereas free air in the spinal canal (pneumorrhachis) is a very rare complication of cocaine abuse. In this report we present a case of pneumorrhachis that developed after cocaine use. Case. A 28-year-old male patient was admitted to the emergency department with shortness of breath, chest pain, and swelling in the neck and face which started four hours after he had sniffed cocaine. On physical examination, subcutaneous crepitations were felt with palpation of the jaw, neck, and upper chest area. Diffuse subcutaneous emphysema, pneumomediastinum, and pneumorrhachis were detected in the computed tomography imaging. The patient was treated conservatively and discharged uneventfully. Discussion. Complications such as pneumothorax, pneumomediastinum, and pneumoperitoneum that are associated with cocaine use may be seen due to increased intrathoracic pressure. The air then may flow into the spinal canal resulting in pneumorrhachis. Emergency physicians should know the possible complications of cocaine use and be prepared for rare complications such as pneumorrhachis.
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Pereira RB, Andrade PB, Valentão P. A Comprehensive View of the Neurotoxicity Mechanisms of Cocaine and Ethanol. Neurotox Res 2015; 28:253-67. [PMID: 26105693 DOI: 10.1007/s12640-015-9536-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/09/2015] [Accepted: 06/16/2015] [Indexed: 01/17/2023]
Abstract
Substance use disorder is an emerging problem concerning to human health, causing severe side effects, including neurotoxicity. The use of illegal drugs and the misuse of prescription or over-the-counter drugs are growing in this century, being one of the major public health problems. Ethanol and cocaine are one of the most frequently used drugs and, according to the National Institute on Drug Abuse, their concurrent consumption is one of the major causes for emergency hospital room visits. These molecules act in the brain through different mechanisms, altering the nervous system function. Researchers have focused the attention not just in the mechanism of action of these drugs, but also in the mechanism by which they damage the nervous tissue (neurotoxicity). Therefore, the goal of the present review is to provide a global perspective about the mechanisms of the neurotoxicity of cocaine and ethanol.
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Affiliation(s)
- Renato B Pereira
- REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Rua de Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal
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Seyit M, Erdur B, Kortunay S, Yuksel A, Yilmaz A, Ozen M, Uyanik A, Tomruk O, Ergin A. A Comparison of Dexmedetomidine, Moxonidine and Alpha-Methyldopa Effects on Acute, Lethal Cocaine Toxicity. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e18780. [PMID: 26290748 PMCID: PMC4537789 DOI: 10.5812/ircmj.17(5)2015.18780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/02/2014] [Accepted: 01/18/2015] [Indexed: 02/02/2023]
Abstract
Background: The treatment of cocaine toxicity is an important subject for emergency physicians. We investigated the effects of dexmedetomidine, moxonidine and alpha-methyldopa on acute cocaine toxicity in mice. Objectives: The aim of this study was to evaluate the effects of dexmedetomidine, moxonidine and alpha-methyldopa in a mouse model of acute cocaine toxicity. Materials and Methods: We performed an experiment consisting of four groups (n = 25 each). The first group received normal saline solution, the second group received 40 µg/kg of dexmedetomidine, the third group received 0.1 mg/kg of moxonidine and the fourth group received 200 mg/kg of alpha-methyldopa, all of which were intraperitoneally administered 10 minutes before cocaine hydrochloride (105 mg/kg). All animals were observed for seizures (popcorn jumping, tonic-clonic activity, or a loss of the righting reflex) and lethality over the 30 minutes following cocaine treatment. Results: The ratio of animals with convulsions was lower in all treated groups when compared to the control (P < 0.001). Furthermore, 68% (n = 17) of animals in the dexmedetomidine group, 84% (n = 21) of the alpha-methyldopa group, 92% (n = 23) of the moxonidine group and 100% (n = 25) of the control group showed evidence of seizure activity (P = 0.009). Cocaine-induced lethality was observed in 12% (n = 3) of the dexmedetomidine group, 48% (n = 12) of the alpha-methyldopa group, 52% (n = 13) of the moxonidine group, and 72% (n = 18) of the control group (P < 0.001). All treatments prolonged the time to seizure, which was longest in the dexmedetomidine group (P > 0.05). In addition, the time to lethality was also longer in the same group (P < 0.001). Conclusions: The present study provides the first experimental evidence in support of dexmedetomidine treatment for cocaine-induced seizures. Premedication with dexmedetomidine reduces seizure activity in a mouse model of acute cocaine toxicity. In addition, while dexmedetomidine may be effective, moxonidine and alpha-methyldopa did not effectively prevent cocaine-induced lethality.
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Affiliation(s)
- Murat Seyit
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Bulent Erdur
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, Denizli, Turkey
- Corresponding Author: Bulent Erdur, Department of Emergency Medicine, Medical Faculty, Pamukkale University, Denizli, Turkey. Tel: +90-2582134812, E-mail:
| | - Selim Kortunay
- Department of Pharmacology, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Aykut Yuksel
- Department of Emergency Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Atakan Yilmaz
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Mert Ozen
- Department of Emergency Medicine, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
| | - Aykut Uyanik
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Onder Tomruk
- Department of Emergency Medicine, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
| | - Ahmet Ergin
- Department of Public Health, Medical Faculty, Pamukkale University, Denizli, Turkey
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49
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Voon P, Callon C, Nguyen P, Dobrer S, Montaner JSG, Wood E, Kerr T. Denial of prescription analgesia among people who inject drugs in a Canadian setting. Drug Alcohol Rev 2014; 34:221-8. [PMID: 25521168 DOI: 10.1111/dar.12226] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 10/05/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND AIMS Despite the high prevalence of pain among people who inject drugs (PWIDs), clinicians may be reluctant to prescribe opioid-based analgesia to those with a history of drug use or addiction. We sought to examine the prevalence and correlates of PWIDs reporting being denied of prescription analgesia (PA). We also explored reported reasons for and actions taken after being denied PA. DESIGN AND METHODS Using data from two prospective cohort studies of PWIDs, multivariate logistic regression was used to identify the prevalence and correlates of reporting being denied PA. Descriptive statistics were used to characterise reasons for denials and subsequent actions. RESULTS Approximately two-thirds (66.5%) of our sample of 462 active PWIDs reported having ever been denied PA. We found that reporting being denied PA was significantly and positively associated with having ever been enrolled in methadone maintenance treatment (adjusted odds ratio 1.76, 95% confidence interval 1.11-2.80) and daily cocaine injection (adjusted odds ratio 2.38, 95% confidence interval 1.00-5.66). The most commonly reported reason for being denied PA was being accused of drug seeking (44.0%). Commonly reported actions taken after being denied PA included buying the requested medication off the street (40.1%) or obtaining heroin to treat pain (32.9%). DISCUSSION AND CONCLUSIONS These findings highlight the challenges of addressing perceived pain and the need for strategies to prevent high-risk methods of self-managing pain, such as obtaining diverted medications or illicit substances for pain. Such strategies may include integrated pain management guidelines within methadone maintenance treatment and other substance use treatment programs.
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Affiliation(s)
- Pauline Voon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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50
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Liangos O. Resistant hypertension and renal denervation: what do the guidelines say? A nephrologist's perspective. Interv Cardiol 2014. [DOI: 10.2217/ica.14.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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